Impact of the COVID-19 Pandemic on Corneal Transplantation: A Report From the Italian Association of Eye Banks

Abstract

PurposeTo analyze the impact of COVID-19 on Italian corneal transplantation from March-2020 to February 2021 compared to the same timeframe of the 2 previous years, in order to identify potential consequences of a global pandemic on corneal procurement and transplantation services during this time.MethodsThis national, multicentric, retrospective cohort study evaluated data collected from 12 (100%) Italian eye banks from March 2020 to February 2021 (Group A). The number of tissues collected, distributed and discarded were compared with the same time-frame of the 2 previous years: 2019 and 2018 (group B and C, respectively). The different type of transplants performed were reported. Data were analyzed using a non-parametric Friedman test.ResultsCorneal procurement and the percentage of distributed tissues reduced in 2020 by more than 30 and 15%, respectively, compared to the 2 previous years. During the pandemic corneal transplant surgery showed only a modest drop: the number of the penetrating keratoplasties (PKs) and the anterior lamellar keratoplasties (ALKs) decreased by about 30 and 20% in comparison with groups B and C, respectively; between the Endothelial Keratoplasties (EKs), the Descemet membrane endothelial keratoplasty (DMEK) increased slightly from March 2020 to February 2021.ConclusionsItaly was one of the first countries most affected by the outbreak of COVID-19, and the Italian government adopted severe measures to limit viral transmission. The pandemic generated several implications in corneal transplant activity during the first lockdown. Then an efficacious reaction with constant, vigorous work led to a resumption of transplant surgery to a near-normal standard. The increase of EKs, despite the pandemic, is a sign that the advance in corneal transplantation has gone ahead and it continues to evolve.

Global impact of COVID-19 on corneal donor tissue harvesting and corneal transplantation

“…The EBAA data revealed a decrease in EK proportions and an increase in PK proportions during the lockdown in the US, however the proportions were once again similar to pre-pandemic values after the restrictions were lifted ( 28 ). Mencucci et al ( 15 ) showed a decrease in the rates of both PKs and ALKs due to the suspension of elective surgeries. PKs showed a steeper decline, explained by the general trend of preferring ALKs over PKs in recent years.…”

Effect of Covid-19 on Eye Banks and Corneal Transplantations: Current Perspectives

“…However, despite the critical slide during the pandemic peaks, the Eye Bank Institutions, and the corneal transplant industry responded positively, with an immediate restoration of their activities, undoubtedly demonstrating at the same time compliance and serendipity. 3 , 9 …”

“…16,86 However, despite the critical slide during the pandemic peaks, the Eye Bank Institutions, and the corneal transplant industry responded positively, with an immediate restoration of their activities, undoubtedly demonstrating at the same time compliance and serendipity. 3,9 Undoubtedly harmful, the global pandemic represented an opportunity for brainstorming, thoughtful thinking, and introspection. Besides, it has provided the system with the chance to reconsider old processes and to formulate new solutions and ideas.…”

“…7,8 Meanwhile, the redirection of the health care, human and economic resources towards COVID-19 departments, resulted in the disruption of the ophthalmic services in many institutions. 3,[9][10][11][12] As a consequence, the Eye Bank Institutions worldwide have been facing unprecedented and unforeseeable operational challenges, with a considerable reduction in the number of both procured and distributed corneoscleral buttons, as well as with an increased proportion of discarded corneas due to non-use. 13 For instance, the Eye Bank Association of America (EBAA) reported for the 2020 a ~20% reduction in tissue procurement (54,740 donors in 2020, compared with 68,759 in 2019).…”

“…17 The interruption in corneal transplant activity during the peaks of the pandemic, has resulted in a variable number of disqualified corneas, due to non-use, as variably reported in the literature. 3,9 In fact, corneal tissues maximum storage time depends on the preservation technique used, but it does not generally exceed 34 days. 3 Specifically, various methods have been proposed over the years for long term corneal tissues depot, with glycerol preservation, lyophilization, and gamma irradiation being the most promising ones.…”